Paola DomizioProfessor of Pathology Education, at Barts and the London, Queen Mary's School of Medicine and Dentistry

Interview location: Pathology building at Barts and the London, Whitechapel, London
Interview date
: 9th October, 2007


Key Themes: Attributes of a Pathologist, Autopsy, ChildrenLife, death and the hereafterRelationship with clinicians

 

Profile | Transcript Summary | Full Transcript

 

Section 1

  • Tells the story of her parents’ departure from Italy, and a poor farming background, to settle in Islington, London.  They struggled financially, but she went to a good state school and did very well. Admits her choice of medicine was rather random.  “I was quite academic, I'd always come top of my class.  The two academic subjects in those days were law and medicine, and I didn't fancy doing law.”
  • Out of “intellectual curiosity” she did an intercalated degree in cell biology and anatomy.  Decided to specialise in surgery, which “I thought at the time (I now know differently), was more intellectual and would be more satisfying”.  The hours involved were “hellish... I had no time to study, no time for any kind of life, and I felt I just couldn't maintain this long term.”
  • Answered an advertisement for a job in pathology, and started work at Barts Hospital. 
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Section 2

  • Admits it took her time to settle down. She is “quite a gregarious” person. “Suddenly going into a morgue was quite off-putting...  Actually it's quite gory and smelly.  And quite hard work, particularly if you're a smallish woman, to try and eviscerate from a large man.”
  • Describes how she achieved professional detachment, but says: “The first time I did an autopsy on a child was very different.” In this case the child was still dressed, and “I really had to force myself to take the knife and make that cut.” Even now she feels “Children are always worse because you read the histories... [there’s an] overwhelming feeling of sadness.”
  • Comments that she has mastered her feelings because of “the advantages at the end of the day and the benefits that [postmortem] can bring”.
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Section 3

  • Describes technical aspects of a postmortem, including what the mortuary technicians do
  • Regrets the decline in autopsy rates.  Despite the improvements in technology, “all the studies looking at ... antemortem and postmortem diagnosis still show a major discrepancy rate of about 10%.” 
  • Mentions some of the reasons for decline, but gives a graphic example of how the findings of a postmortem can have very significant consequences for families.
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Section 4

  • Turns to surgical pathology, which now takes up the majority of her time, and describes how accumulating experience with microscopy is an incredibly important part of becoming a good pathologist.  “I remember being really interested and struck by how wide a spectrum of disease I was seeing, which would not be the case on the wards.”
  • Mentions that another reservation she had about specialising in surgery is that “it's inevitable that at some point your actions will cause the death of a patient”.  Acknowledges that mistakes do happen in pathology too, something she finds particularly hard to come to terms with. “Histopathology is not a science in the classical sense... [It]is a subjective interpretation of appearances down a microscope based on your previous experience and your knowledge of the patient's history.” 
  • Explains that the interpretation of slides“can be very, very difficult: benign conditions can mimic malignancy, and vice versa”.  Gives an example of a puzzling case that emphasises the important of good cooperation between clinicians and pathologists. 
  • Describes how soon after she qualified as a pathologist, HIV became an issue in autopsies, and some of the early precautions adopted to protect staff from infection.  “We were supposed to wear chainmail gloves to stop us cutting our fingers.”
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Section 5

  • Explains that, despite the prevailing public opinion of pathologists as ‘doctors of death’, “most of pathology actually deals with the living.”  Makes the point that “70% of diagnoses in the health service depend on a pathologist ... [They] form the platform on which subsequent management of the patient occurs.” 
  • Gives a bit of the history of shifts in emphasis in medical education.   A belief that students were being “overloaded with facts”, led to a downgrading of pathology in the curriculum in the early 70s.  But “there's the beginning of a groundswell to say that, well, we actually need to put back some of the basic sciences.”
  • Reiterates that it’s the variety of pathology that appeals, and explains also that the hours are more routine and “compatible with a normal life”.
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Section 6

  • Relates a personal anecdote about the difficult circumstances in which she gave her first paper at the Pathological Society.  “I have never again, to this day, given a talk feeling so bad for so many different reasons!”
  • Talks a bit about how proximity to disease and death has made her “a bit more accepting” of its inevitability. 
  • Muses briefly on religion.  “Because I'm a scientist I like to find reasons for things...[but]  I personally don't think... [religion and science] are completely incompatible.”
  • Describes briefly the two people who have most inspired her.  “Both of them were atypical pathologists in the sense that they were… very extrovert, very open.”  Notes that they were particularly engaging teachers. “I'm a bit like that, quite extrovert... I like standing up in front of students and acting a bit silly and making them enjoy it and making them laugh.”
  • Teaching is one of the most enjoyable parts of her job:  “I'm inspired by the students learning, I'm inspired by the fact that they seem to enjoy it, I'm inspired by getting the problem students through.”

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Section 7

  • Discusses the attributes of a good pathologist.  Besides good pattern recognition, she believes one has to be good at written communication: “You have to have a skill in putting what you're seeing down the microscope into words.”
  • Identifies lack of thoroughness as “probably the most serious fault in a potential pathologist.”  Gives some examples to illustrate this point.
  • Talks about how the role of the pathologist within hospital medicine waned from being one of the most prominent, to being relegated to the ‘backroom’, “and nobody taking any notice of you”.   With the rise of multidisciplinary teams, pathologists are now more valued.  “It's one of the standards by which the multidisciplinary teams are assessed – the presence of a pathologist.”  However, she feels, the importance of pathology has “yet to translate itself into medical education”.

 

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Section 8

  • Discusses some of the high points in her career, which include prestigious appointments within the Royal College of Pathologists.  “Being appointed as a professor was obviously nice – particularly for my parents... No one's ever been to university in their respective families, ever.”  
  • Pays tribute to her parents.  “I think my parents' philosophy in life has always been my guiding light... You will succeed if you work hard.”
  • Talking about how important being a pathologist is to her sense of self, she concludes:  “The fact that I come from an immigrant family that was poor and Italian has been more of a defining feature of my life than anything.” 

 

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